Kidney removed from awake patient at Molinette in Turin, it’s the first time in Europe

In Turin, for the first time in Europe, a kidney with a large tumor was removed in a patient operated on while awakeThe operation was performed on a 76-year-old woman in critical condition using the latest-generation robotic system ‘da Vinci Single Port’, a single-access robot surgeon, at the Urology Clinic of the Molinette hospital directed by Paolo Gontero.

The woman – they explain from the Città della Salute of the Piedmontese capital, the university hospital company that heads the Molinette hospital – had recently been diagnosed with an 8-centimeter tumor in her right kidney. The only possible cure was the radical removal of the organ, but the patient also suffered from severe respiratory failure that forced her to live attached to an oxygen tank with the need for frequent hospitalizations, as well as severe obesity that further complicated the already complex picture. The anesthetists had immediately declared the woman inoperable, because her body would not have been able to withstand the general anesthesia necessary for this type of surgery. The only alternative was to attempt the operation with a loco-regional anesthesia, that is, making the area to be operated on numb, but keeping the patient conscious. To increase the chances of success, however, it was necessary to use the least invasive surgical technique possible, capable at the same time of guaranteeing the complete removal of the cancer.

Although the Molinette Urology Clinic boasted “ample experience with numerous cases of patients bordering on the impossible,” the AOU emphasizes in a note, the difficulties were objective “also due to the size of the tumor which, together with obesity, made the entire mass to be removed of extraordinary dimensions.” But Gontero and colleagues took up the challenge, assisted by the new robotic system.

Da Vinci Single Port is a latest-generation single-access technology recently acquired thanks to the support of the Crt Foundation, the note describes. This solution has made it possible to operate with a single 2.5 cm working port containing 4 miniaturized instruments that are inserted into the abdomen through a single cut. Compared to the Multi Port systems, widely used and which remain the gold standard in numerous interventions, the Single Port is particularly indicated in cases in which further reducing invasiveness through an alternative access is crucial for the patient.

“The choice of the da Vinci Single Port robotic system proved to be the winning strategy – says Gontero who performed the operation together with Daniele D’Agate – because the finesse of its 4 instruments, which are operated by the operator like the tentacles of an octopus, allowed to minimize the surgical trauma, thus reducing the painful traumatic stimuli to the patient and at the same time ensuring great precision in movements and speed of action. The operation was made possible only by the combination of the new minimally invasive technology, which made it possible to remove a large mass using an access port of a few centimeters, and an excellent anesthesiology team specialized in this type of anesthesia. The operation saw the fundamental collaboration of Dr. Giulio Rosboch and Dr. Edoardo Ceraolo, of the university anesthesiology team directed by Professor Luca Brazzi, and of the operating room nursing team coordinated by Dr. Filippa Converso. The patient was discharged in good condition after only 3 days of hospitalization.”

The new robot is at the center of a research project in which Mario Morino, director of the University Surgery Clinic of the Molinette hospital, participates, for a multidisciplinary use in oncological surgery. “A new frontier of surgery that reconciles the technological aspect and medical professionalism for a new goal achieved, which confirms for the umpteenth time the excellence of our City of Health”, declares Giovanni La Valle, general director of the Aou.